Baltimore Sun

Abortion ban debate turns to options

Experts point out ‘morning after pills’ not 100% effective

- By Amy Forliti

MINNEAPOLI­S — Some leaders in states with strict abortion bans say exceptions for rape or incest victims aren’t needed because emergency contracept­ives can be used instead. But medical profession­als and advocates for rape survivors say that while emergency contracept­ion is a helpful tool, it’s not always foolproof, and getting access to these emergency measures in the short time frame in which they would be effective may not be realistic for someone who has just been assaulted.

Here’s a look at emergency contracept­ives and what some people are saying.

Emergency contracept­ives:

The contracept­ives are used to prevent pregnancy after unprotecte­d sex or if a method of birth control fails.

Two types of medication­s, sometimes referred to as “morning after pills,” are available: levonorges­trel, known by the popular brand name Plan B; and ulipristal acetate, known under the brand ella. They should be taken as soon as possible after unprotecte­d sex.

The pills prevent ovulation,whichiswhe­naneggis released from an ovary, said Dr. Jonah Fleisher, director of the Center for Reproducti­ve Health at the University of Illinois in Chicago. If an egg is not released, it cannot be fertilized.

The difference­s: Are emergency contracept­ives the same as abortion pills? No. Emergency contracept­ives prevent a pregnancy. The abortion pill, mifepristo­ne, ends a pregnancy after a fertilized egg has implanted

in the lining of a woman’s uterus. It’s commonly administer­ed with the drug misoprosto­l and can be taken up to 11 weeks after the first day of a woman’s last period.

Pills’ effectiven­ess: Emergency contracept­ive do not work 100% of the time. The pills’ effectiven­ess improves the sooner they are taken after unprotecte­d sex, doctors said. The drugs won’t prevent pregnancie­s if they are taken before sex, Fleisher said.

The Food and Drug Administra­tion has approved Plan B for use up to 72 hours, or three days, after unprotecte­d sex. Ella is approved for up to 120 hours, or five days.

Timing is important because sperm can live inside a woman’s body for up to five days, so a woman can still get pregnant if ovulation occurs after intercours­e, said Dr. Dana Stone, an OB-GYN in Oklahoma City. If a woman has ovulated prior to intercours­e, the pills are unlikely

to help.

“So that’s where the failure comes in. It’s based on the timing,” Stone said.

A woman’s weight also may play a role, though there is conflictin­g informatio­n on that. Guidance from the American College of Obstetrics and Gynecology says levonorges­trel may be less effective in women with a body mass index that’s over 25. The organizati­on says some research suggests ulipristal acetate also has lower effectiven­ess among women with a BMI that’s 30 or higher.

However, the FDA found conflictin­g data and reached no conclusion in a 2016 review of the effectiven­ess of levonorges­trel in women who weigh more than 165 pounds or have a BMI above 25. The agency said additional research should be a priority.

Another form of emergency contracept­ion, a copper intrauteri­ne device, is seen as the most effective method, if inserted into a woman’s uterus within five days of unprotecte­d sex. Its

effectiven­ess is not dependent on weight, Fleisher said.

A doctor or nurse must insert a copper IUD, which can remain in place for many years as a regular form of birth control.

Plan B can be purchased over the counter by anyone 17 or older, but younger people need a prescripti­on. Ella requires a prescripti­on.

What officials say: Officials in some states, such as Texas Gov. Greg Abbott and South Carolina state Rep. Doug Gilliam, point to emergency contracept­ives as a reason abortion bans don’t need exceptions for rape or incest.

During an Aug. 31 House debate, Gilliam said, in a hypothetic­al case of a 12-year-old raped by her father, the child would have “choices” and wouldn’t be “forced” to carry a pregnancy. Among them, he said, she could go to the hospital and get an emergency contracept­ive, or go to the store and get one without a prescripti­on.

Pressed by a fellow lawmaker on who would take the girl to the store to get the pill, he initially replied “The ambulance,” then corrected himself and said, “The hospital when she’s there.”

In a follow-up interview with The Associated Press, the Republican lawmaker said he did not mean to suggest that an ambulance would take a girl to a store, but that if she were to go to the hospital, she would likely be offered emergency contracept­ion.

“I don’t want anybody to think that I told you a 12-year-old that just been raped is going to call an ambulance to go to a store,” he said. “I just let them know the options were out there, and one of them was emergency medical contracept­ives.”

Rape victims: Most rape victims don’t report the crime to law enforcemen­t, according to Jude Foster, advocacy medical forensic and prevention programs director for the Minnesota

Coalition Against Sexual Assault. Many also may not go in for immediate medical care. Not everyone knows that emergency contracept­ives are an option and part of a routine rape exam, or that such an exam is free.

“Why is sexual assault used as a political football when you are talking about access to reproducti­ve care?” Foster said. “Please don’t. It just really frustrates me.”

Stone said the belief that a woman can just take Plan B if she is raped is misguided.

“We need all kinds of options for women because nothing is a one size fits all,” Stone said. “People have transporta­tion problems, they have financial problems. There are always barriers to some percentage of women that will keep them from accessing this in the short time frame that they have.”

State laws: Several states have explicitly allowed for emergency contracept­ion in their abortion laws.

Arkansas, Kentucky and Oklahoma all have laws that ban abortion at all stages of pregnancy, and make no exceptions for cases of rape or incest. Arkansas’ and Kentucky’s laws explicitly say they don’t prohibit contracept­ive measures if they are used before a pregnancy can be determined. Oklahoma’s abortion ban also does not apply to emergency contracept­ion.

Abortion bans aside, the National Conference of State Legislatur­es says 21 states and the District of Columbia have statutes related to accessing emergency contracept­ion, and 16 of them and the District of Columbia require hospitals or health care facilities to provide informatio­n about or administer emergency contracept­ion to women who have been sexually assaulted.

 ?? ELISE AMENDOLA /AP 2013 ?? A pharmacist holds a generic emergency contracept­ive at Health First Pharmacy in Boston.
ELISE AMENDOLA /AP 2013 A pharmacist holds a generic emergency contracept­ive at Health First Pharmacy in Boston.

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